Orca Orthodontics! Orca is the genus of the killer whale, and at one point I thought that was the perfect name for my practice. I felt like I was treating only people with a “whale of a problem.” Fortunately, my wife didn’t share my temporary insanity and wisely stopped me from naming the practice that way.
Later, I began referring to my patient base as “train wreck patients” who had everything imaginable going wrong. Again, my wife Deb jumped in and extinguished those flames before I could brand the practice with another misguided idea.
During one of our brainstorming sessions, we came up with the acronym E.R.R.S.™ (Extraction Retraction Regret Syndrome™). People immediately identified E.R.R.S.™ as a mistake. We both liked the sound of it and trademarked the term. Just another great reason I married her.
We define E.R.R.S.™ as:
“…a constellation of esthetic, functional, and emotional signs and symptoms brought on by orthodontic retraction.”
It is preventable because retraction is preventable.
When I introduce E.R.R.S.™ to dental audiences, it often elicits a chuckle. We chuckled too when we first created it. But in reality, E.R.R.S.™ is deadly serious.
People worldwide have contacted me, describing themselves as “a poster child for E.R.R.S.™.” Too many have suffered for so long that they are suicidal. Some may never fully recover no matter what treatment is done.
Treating E.R.R.S.™ is difficult. Preventing it is far easier.
In my early years, I extracted teeth in more than half my cases. I stopped nearly 45 years ago, even in patients with the worst crowding. The sky did not fall.
McNamara’s July 1981 Angle Orthodontist article on Class II cases made me realize the maxilla is recessed and needs to be developed forward with the mandible to optimize facial balance and airway.
These elastics retract maxillary anteriors and can cause problems. Leave patients Class II if you cannot camouflage the overjet with my protocol or if they decline MMA surgery.
If you must close spacing for esthetics, do so without retraction and “bury space” in the posterior segment, such as between the second bicuspids and first molars.
Herbst, MARA, Forsus, Twin-Block, and similar appliances are marketed as able to “grow” the mandible, but there is no evidence to support that claim. I was an early adopter of the Herbst and later realized its airway effects were negative.
This measurement—from the tip of the nose to the edge of an upper incisor—should ideally increase by only 1 mm per year. Faster changes mean the maxilla and incisors are falling down and back. Learn more about this diagnostic tool.
This may involve myofunctional therapy, oral tissue releases, nasal or tonsil treatments, lip taping at night, and both lateral and anteroposterior expansion to create space for the tongue.
Only with proper rest oral posture will the face grow forward to create balance and an open airway. But do not expect the face to catch up after years of poor oral posture and retraction. Early intervention is critical.
E.R.R.S.™ is not just a catchy acronym. It is a serious and preventable problem. By avoiding retraction and focusing on airway and facial balance, orthodontists can protect patients from lifelong consequences.
